Synovial osteochondromatosis of the temporo-mandibular joint

Clinical and radiologic findings of synovial chondromatosis affecting the temporomandibular joint

OBJECTIVES

Our aim was to study the clinical and radiologic findings of synovial chondromatosis (SC) affecting the temporomandibular joint (TMJ) and provide references for diagnosis and treatment.

STUDY DESIGN

Twenty patients confirmed as SC histopathologically were included in the investigation. Nineteen cases were treated with arthrotomy and 1 case with arthroscopy. The clinical manifestations, radiographic findings, histopathologic features, surgical treatment, and differential diagnosis were combined to study this disease. The SC features of TMJ on magnetic resonance (MR) images were summarized on proton density-weighted (PD) and T2-weighted images.

RESULTS

Synovial chondromatosis of TMJ occurred more often in women and on the right. Symptoms included preauricular pain, swelling, limitation of mouth opening, crepitations, and deviation on opening. The detection rate of calcified loose bodies was 30% on conventional radiographs and 53.3% on computerized tomography. Multiple small ring-like or tubular signals could be seen on PD and T2-weighted MR images. SC mainly affected the superior joint space; it could involve the inferior space when a perforated or deformed disc was present. SC could extend into intracranial fossa, infratemporal fossa, and lateral pytergoid muscle.

CONCLUSIONS

The characteristic ring-like signals could be found on MR images of the patients with SC of TMJ. This lesion should be differentially diagnosed with TMJ disorders and preauricular masses. Considering its recurrence and the different behavior of SC in different patients, various treatment strategies should be considered.

Osseous abnormalities related to the temporomandibular joint

With the arrival of arthrography, computed tomography, and magnetic resonance imaging, diagnostic imaging of the temporomandibular joint has improved tremendously over the last 20 years. In patients with temporomandibular joint pain and dysfunction, the main focus was on meniscal pathology. The purpose of this article is to discuss several osseous abnormalities and demonstrate their association with temporomandibular joint pain and dysfunction.

Common abnormalities in temporomandibular joint imaging

Magnetic resonance imaging has evolved as a prime diagnostic method for soft-tissue abnormalities of the temporomandibular joint. The most common temporomandibular joint abnormalities are internal derangement and osteoarthritis, but there are many other reasons for pain and dysfunction that are often overlooked. The purpose of this paper is to illustrate several of these more unusual and less well-recognized causes for temporomandibular joint pain and dysfunction. For example, internal derangement is often seen in asymptomatic individuals. Another purpose is to illustrate the difference in magnetic resonance imaging of asymptomatic and symptomatic internal derangement.

Temporomandibular joint: MR imaging

Diagnostic imaging of TMJ has improved remarkably in the last 20 years. Various abnormalities related patient symptoms. Further studies using the latest imaging techniques will allow a better understanding of the sources of joint pain and the discrepancy between imaging findings and patient symptoms. For clinical practice, appropriate clinical examinations are needed to determine exactly which imaging findings are significant.

Synovial chondromatosis of the temporomandibular joint: clinical, diagnostic, and histomorphologic findings

Objective. The primary diagnosis of synovial chondromatosis of the temporomandibular joint is extremely rare. Often many months, or even years pass before the diagnosis is confirmed. Study Design. Eight patients with synovial chondromatosis were treated by arthrotomy. In addition to the definitive diagnosis, histologic classification according to the stages proposed by Milgram was undertaken and confirmed with the literature. Results. The predominant symptoms of synovial chondromatosis, including pain, swelling, restricted movement of the mandible, and crepitation, were evaluated. Nevertheless, more than 80% of the patients were previously primarily treated on the basis of other tentative diagnoses. Conclusion. Synovial chondromatosis of the temporomandibular joint should be included in the differential diagnosis of chronic swelling and pain in the preauricular region, and the patient should be sent for appropriate diagnostics and therapy at an early stage.

Condylar hyperplasia associated to synovial chondromatosis of the temporomandibular joint: a case report

Condylar hyperplasia is a slowly developing malformation of the mandible, with elongation of the mandibular neck, that generally results in facial asymmetry. Synovial chondromatosis is a benign chronic disorder characterized by the formation of multiple small nodules of hyaline cartilage as a result of metaplasia of the synovial connective tissue. It affects mostly the large joints, particularly the knee, hip, elbow and ankle. The temporomandibular joint (TMJ) is rarely affected. The case of a 42-year-old male with a history of left preauricular pain and swelling and deviation of the mandible to the left upon opening the mouth is presented. Computed tomography disclosed hyperplasia of the left condyle with loose radiopaque bodies within the joint cavity. The left TMJ was subject to open surgery, which included resection of four loose bodies and a remodeling condylectomy. The histopathological study confirmed the diagnosis of condylar hyperplasia and chondromatosis of the left TMJ.

Synovial chondromatosis of the temporomandibular joint: varying presentation in 4 cases

Synovial chondromatosis is a rare condition in which cartilage is formed in the synovial membrane of a joint. The manifestations of this benign neoplastic process can mimic many common temporomandibular joint and parotid diseases. Four cases of synovial chondromatosis are presented. In each case, atypical presentation, coexisting joint disease, or both caused diagnostic confusion. The histories and physical examinations were initially consistent with more common joint diseases in each case. Imaging provided some insight into diagnosis and was a definitive indication for surgical treatment. Treatment by subtotal synovectomy and by removal of chondromatous nodules were undertaken in each case. No patient in our series has had recurrence of disease or symptoms after surgical treatment.

Bizarre parosteal osteochondromatous proliferation in the anterior maxilla: report of a case

Bizarre parosteal osteochondromatous proliferations are a rare subgroup of the osteochondromatous lesions. They must be differentiated from reactive osteochondromatous proliferations, low grade parosteal osteogenic sarcoma, and chondrosarcoma. Their recognition is important from the point of view of management, which should be by simple excision. This article describes a case of bizarre parosteal osteochondromatous proliferation in a 2-year-old child; the lesion developed in the anterior maxilla, a previously unreported site.

Synovial chondromatosis of the temporomandibular joint with intracranial extension

An unusual case of synovial chondromatosis of the temporomandibular joint with intracranial extension, which resulted in complete dehiscence of the floor of the middle cranial fossa, is reported. An overview of the current literature and a discussion of the diagnosis and surgical management of synovial chondromatosis are presented.

[Synovial chondromatosis of the temporomandibular joint with invasion into the middle cranial fossa]

Synovial chondromatosis of the temporomandibular joint is a rare occurrence. Resorption of the floor of the skull base caused by the tumour with invasion into the middle cranial fossa has only been described a few times. We report on diagnosis, histologic examination and therapy of a patient with synovial chondromatosis in the articular tubercle of the right temporomandibular joint invading the middle and cranial fossa. After tumour exstirpation the defect in the floor of the middle cranial fossa was reconstructed using a split-skull graft via an intracranial approach.